Background: The SCOFF questionnaire (Morgan, Reid and Lacey, 1999) is a five item measure, developed to serve as a simple, easy to remember screening tool for eating disorders. The instrument was designed for use by professionals and non-professionals alike and can be used in primary health care settings. The SCOFF items were developed via focus groups with eating disordered patients and specialists in the field (Morgan et al, 1999). Questions can be administered orally or in written format (Perry et al, 2002).
Measurement: The SCOFF Questionnaire is a five-question screening tool designed to clarify suspicion that an eating disorder might exist rather than to make a diagnosis. The questions can be delivered either verbally or in written form.
S – Do you make yourself Sick because you feel uncomfortably full?
C – Do you worry you have lost Control over how much you eat?
O – Have you recently lost more than One stone (6.35 kg) in a three-month period?
F – Do you believe yourself to be Fat when others say you are too thin?
F – Would you say Food dominates your life?
An answer of ‘yes’ to two or more questions warrants further questioning and more comprehensive assessment. A further two questions have been shown to indicate a high sensitivity and specificity for bulimia nervosa. These questions indicate a need for further questioning and discussion.
- Are you satisfied with your eating patterns?
- Do you ever eat in secret?
Scoring: Each “yes” response to the five yes/no questions on the SCOFF is summed for the total score. Scores of 2 or greater were originally set a cut-off point for maximum sensitivity to detect anorexia and Bulimia nervosa (Morgan et al, 1999). A cut-off point of 3 has been suggested as the best compromise between sensitivity and specificity.
Psychometrics: A meta analyses of 15 studies examining the utility of the SCOFF found that the 5 questions of the SCOFF constitute a highly efficient tool for the detection of eating disorders, even by a non-specialist, in several languages. Its use as a screening tool is highly recommended.
Strengths: Readability, ease of use, time efficient, effective, available and validated in other languages.
Limitations: SCOFF is a Self-report measure, may be less effective for male and older people who may present with different symptomology, does not screen for excess exercise, past weight loss
Access: Free and easily accessible. The SCOFF was developed in the United Kingdom but items have been adapted for use in the United States (Morgan et al, 1999; Parker, Lyons and Bonner, 2005). German, Finnish, Spanish and Japanese translations of the SCOFF have also been developed.
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Garcia-Campayo, J., Sanz-Carrillo, C., Ibañez, J., Lou, S., Solano, V. and Alda, M. (2005). Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care. Journal of Psychosomatic Research, 59(2), pp.51-55. Doi:10.1016/j.jpsychores.2004.06.005.
Lähteenmäki, S., Aalto-Setälä, T., Suokas, J., Saarni, S., Perälä, J., Saarni, S., Aro, H., Lönnqvist, J. and Suvisaari, J. (2009). Validation of the Finnish version of the SCOFF questionnaire among young adults aged 20 to 35 years. BMC Psychiatry, 9(1). Doi:10.1186/1471-244X-9-5.
Pannocchia, L., Fiorino, M., Giannini, M. and Vanderlinden, J. (2011). A Psychometric Exploration of an Italian Translation of the SCOFF Questionnaire. European Eating Disorders Review, 19(4), pp.371-373. Doi:10.1002/erv.1105.
Perry, L., Morgan, J., Reid, F., Brunton, J., O’Brien, A., Luck, A. and Lacey, H. (2002). Screening for symptoms of eating disorders: Reliability of the SCOFF screening tool with written compared to oral delivery. International Journal of Eating Disorders, 32(4), pp.466-472. Doi:10.1002/eat.10093.
Solmi, F., Hatch, S., Hotopf, M., Treasure, J. and Micali, N. (2014). Validation of the SCOFF questionnaire for eating disorders in a multiethnic general population sample. International Journal of Eating Disorders, 48(3), pp.312-316. Doi:10.1002/eat.22373.